Advances in Neurosurgery 6 Treatment of Hydrocephalus Computer Tomography Edited by R. WUllenweber H. Wenker M. Brock M. Klinger With 111 Figures and 86 Tables Spri nger-Verlag Berlin Heidelberg New York 1978 Proceedings of the Joint Meeting of the Deutsche Gesellschaft fUr Neurochirurgie, the Society of British Neurological Surgeons, and the Nederlandse Vereniging van Neurochirurgen Berlin, May 3-6,1978 ISBN-13: 978-3-642-67084-8 e-ISBN-13: 978-3-642-67082-4 DOl: 10.1007/978-3-642-67082-4 Library of Congress Cataloging in Publication Data. Deutsche Gesellschaft fOr Neuro' chirurgie. Treatment of hydrocephalus; Computer tomography. (Advances in neurosurgery; v.6) Includes bibliographies and index. 1. Brain·Diseases-Diagnosis-Congresses. 2. Hydrocephalus-Surgery-Congresses. 3. Tomography-Congresses. 4. Brain-Diseases­ Congresses. I. WUllenweber, R., 1924-. II. Title. III. Series. [DNLM: 1. Hydrocephalus­ Surgery-Congresses. 2. Cerebrospinal fluid shunts-Adverse effects-Congresses. 3. Tomography, Computerized AXIAL-Congresses. WI AD684N v.6 / WL350 T784] RC386.6.T64D481978 616.8'04'7572 78-10202 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, reproduction by photocopying machine or similar means, and storage in data banks. Under § 54 of the German Copyright Law, where copies are made for other than private use, a fee is payable to the publisher, the amount of the fee to be determined byagree­ ment with the publisher. © by Springer-Verlag Berlin Heidelberg 1978 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protec­ tive laws and regulations and therefore free for general use. Preface More than 40 years ago British and German neurosurgeons met in Berlin and Breslau to exchange their experiences, to strengthen their friendly bonds, and to enjoy the attractions of both cities and their surroundings. In 1960 a joint meeting of the Dutch and German societies took place in Rotterdam by invitation of the Nederlandse Vereniging van Neurochirurgen. All who attended this meeting thankfully remember the great hospitality during these unforgettable days. In 1970, by courtesy of the Society of British Neurological Surgeons, German neurosurgeons had the pleasure to become acquainted with the great tradition of British sciences at one of the most famous places during the meeting in Cambridge. These impressions were deepened by visits to other famous sources of British scientific tradition during the European Congress in Oxford in 1975. The critical distance sometimes necessary towards our own discipline is implicit in the major themes of this meeting. Complications following shunting procedures for hydrocephalus have been discussed on the basis of the results of a cooperative study of some German neurosurgical departments. The second main topic was problems and diagnostic errors in computer tomography. The papers presented contain critical considerations about the findings obtained by this method, as well as on its possibilities and limitations. German neurosurgeons felt deeply indebted to their British and Dutch colleagues and wanted to return their kindness at this joint meeting in Berlin. We hope that all participants will retain pleasant memories of the days in this city. In the name of the German Society for Neurosurgery, the organizers of the Joint Meeting in Berlin express their gratitude to Professor G. Finger of Sharp & Dohme GmbH Miinchen for generously supporting the publication and distribution of Advances in Neurosurgery 6. Horst Wenker Rolf Wiillenweber v Reminiscences of the Meeting of 1937 and of Otfrid Foerster1 c. GUTIERREZ2 There are two steps to be taken by those who wish to advance a medical specialty: the formation of a society and the publication of a journal. The birth of the first neurosurgical society was reported by Ernest SACHS in his autobiography [27]: Harvey CUSHING delivered a memorable address on his brain tumor statistics in 1919 before the American College of Surgeons with William MAYO in the chair. At the conclusion Dr. MAYO announced solemnly: "Gentlemen, we have this day witnessed the birth of a new specialty - neurological surgery". After the meeting CUSHING was congratulated by many and he said enthusiastically: "Wouldn't it be a good idea to get the fellows interested in this work together? Why not form a society and hold regular meetings in which we could discuss our problems and compare results? In this way we could make much more rapid progress." This suggestion was followed and the first meeting was held in Boston in 1920. CUSHING was elected president, SACHS secretary, and the first neurosurgical society was founded. The first neurosurgical journal, the Zentralblatt fur Neurochirurgie, was started in Germany in 1936 by TONNIS [15] but not until 1948 was the Deutsche Gesellschaft fur Neurochirurgie founded [8]. The societies mentioned above were established by surgeons. It was different in the Netherlands. The Dutch Study Club for Neurosurgery was formed in 1936 [29], the membership consisting of four neurologists and four neurosurgeons. The initiative came from a neurosurgeon, VERBECK, but it was the neurologist BROUWER, who was the driving force. He was elected the first president and remained so until his death in 1949. The Nederlandse Vereniging van Neurochirurgen was founded in 1952 [29]. When the Society of British Neurological Surgeons (SBNS) was created by Geoffrey JEFFERSON in 1926, it intended to hold two meetings each year, at home in winter and abroad in summer. The first meeting abroad was held in Paris in 1930 and the next in Amsterdam in 1932 which I attended and found wonderfully rich in culture and hospitality, but not very stimulating neurosurgically. I remember how disappointed BROUWER was when OLjENICK, the neurosurgeon in his clinic, outdid CUSHING as regards the most minute operating details, performed a ventricular estimation (which was in fashion at that time), but when he opened the skull he did not find the tumor. The specialty hat not yet gotten on its feet in Holland, but soon thereafter de VET, LENSHOEK, VERBECK, and VERBRIEST brought it to a proper high standard. The summer meeting of 1937 [16, 31] was held in Berlin and Breslau, and again I was a guest of the SBNS. The three days in Berlin included visits to the Neurosurgical Clinic of TONNIS, the Kaiser-Wilhelm-Institut fur Hirnforschung and SAUERBRUCH'S Clinic. A joint meeting was held with the Berlin Medical Society, where President MCCONNELL of 1 Society of British Neurological Surgeons, 29 June to 3 July 1937 at Berlin and Breslau. 2 Institute of the History of Medicine and Neurosurgical Clinic of the University of Gottingen. VI the SBNS lectured on the Chiasmal Syndrome [20,21]. The principal topic of the meeting [32] was intracranial tumors, their nature, and their diagnosis with ventriculography, arteriography and EEG. The distinction from pseudotumor cerebri was discussed by NONNE who had coined the term in 1904 [23]. Other matters considered were subdural hematomas, spasmodic torticollis, and the importance of angiography for the diagnosis and treatment of aneurysms. Among those who read papers were BUSCH (Copenhagen), BERGSTRAND, OLIVECRONA, RINGERTZ and SJOQVIST (Stockholm), TORKILDSEN (Oslo), NONNE (Hamburg), SCHAL TENBRAND (Wiirzburg), and OSTERTAG, SPATZ and ZULCH (Berlin). The trip to Breslau to honor FOERSTER and to visit his institute was especially interesting and pleasant. FOERSTER had close neurological connections with England, having been a devoted disciple of HUGH LINGS JACKSON and of SHERRINGTON. He had given three lectures under the auspices of London University in 1931 [10], the SCHORSTEIN Lecture at the London Hospital in 1932 [11], and the HUGHLINGS JACKSON Centennial Memorial Lecture of the Royal Society of Medicine in 1935 [14]. He was made Emeritus Member of the SBNS at the Breslau meeting where he entertained and instructed us royally with three lectures. These formed a report of the 552 verified tumors of the nervous system which he had collected in 17 years from 12000 admissions to his Neurological Department at the Wenzel-Hancke-Krankenhaus. The social activities included a supper for the entire company at FOERSTER'S villa in Scheitniger Park to which the visitors were transported in a specially provided tram, FOERSTER being of the opinion that the town could be seen better and more comfortably from a tram than from a taxi. FOERSTER restricted his work to Neurology and dedicated all his efforts to establishing neurology as an independent specialty [24]. Neurology had been a stepchild in Germany, at first of internal medicine, later of Psychiatry. ROMBERG, Professor of Therapeutics in Berlin, wrote the first textbook of Neurology in 1840 [26], having been influenced by the writings of Charles BELL, which he translated in 1832 [1]. Soon afterwaards GRIESINGER wrote the first German textbook of psychiatry in 1845 [19], and, declaring that mental illness was due to disease of the brain, brought psychiatry and neurology together for treatment and teaching. This set some psychiatrists to the very productive anatomical study of the brain, among whom were MEYNERT, FOREL, WERNICKE, NISSL and ALZHEIMER. But FOERSTER felt strongly that the field was too wide for one man to straddle and do justice to both specialties, thereby impeding the development of neurology [12]. But in spite of his constant efforts for 40 years, the German regulations for medical education and examination in 1966 [25] still lumped psychiatry and neurology together and stated that the examination in neurology might be conducted by an examiner of internal medicine. When FOERSTER qualified as a physician in 1897 [5], he went to Heiden in Switzerland to study with H. S. FRENKEL and to the DEJERINES in Paris. Straight away he started physiological studies on the sensation and gait of patients with tabes dorsalis [6], which formed the basis for his great success with the treatment of pain, the relief of spastic paralysis, and exercise therapy.